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Amputation Surgery for Peripheral Arterial Disease

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					Useful numbers and contacts
Vascular Ward…………… …… 029

Medical Secretaries for :
Mr A Surgeon                     029
Miss A Surgeon                   029
Mr B Surgeon                     029             Recovery from
Vascular Nurse Specialist        000000000       Open Surgery for
……………………………..                                    Abdominal Aortic
                                                 Aneurysm Repair
                                                 A Patient Recovery
Physiotherapy………………………..029                      Information Leaflet
Occupational therapy……………….029
                                                  Information for patients and carers
Podiatry     ………………………...029
Dietetic Department ………………...029
Social work     ……………………..029




                                             A Vascular Unit
                                             Hospital
                                             Town
Vascular Unit   2011

                            11
Introduction
                                                                 GLOSSARY
You are having, or may have had open surgery to repair
your abdominal aortic aneurysm (AAA). It is important that       Abdomen               The tummy
you feel able to take an active role in your recovery. This      Anaesthetist          Specialist doctor who gives patients the
booklet is designed to give you further information on what to   anaesthetic for an operation.
expect after your operation and advice about recovering          Aneurysm-             A swelling of an artery due to a
from your surgery. It can be used together with information      weakening of the vessel wall by atherosclerosis.
leaflets given to you before your operation.                     Aorta-         The main blood vessel carrying blood from the
                                                                 heart to the whole of the body.
This booklet is designed to answer some of your questions.       Aortic Aneurysm An aneurysm affecting the aorta,
The doctors and nurses and other healthcare professionals        usually in the abdomen area.
involved in your care will also be available to help you with    Artery         Blood vessel taking blood from the heart.
any queries. Our aim is to inform you about what to expect in    Atherosclerosis Narrowing of the artery, by plaque- a
hospital and prepare you for your recovery at home.              fatty substance. It is associated with people who smoke or
The topics covered in this leaflet include:                      have diabetes.
                                                                 Cholesterol           Type of unhealthy fat in the blood.
      Your operation                                            Deep vein thrombosis           A blood clot in the large veins in
      Your early recovery on the ward                           the leg.
      Preparing for discharge                                   Diabetes       A disease where people are unable to control
      Recovery at home                                          the level of sugar in their blood.
      Exercise programme                                        Graft The material used to patch/ repair the diseased
      Complications and what to look out for                    artery. This is a man- made material.
      Outpatient follow up                                      Heparin        Blood thinning drug given by injection to
                                                                 reduce the risk of blood clots.
      Looking after yourself
                                                                 Hypertension          High blood pressure
      Recovery tips
                                                                 Physiotherapist       Healthcare professional trained in the
      Recovery record                                           care of patients to aid recovery with coughing and breathing
      Glossary                                                  exercises and mobility assessment.
      Useful numbers and contacts                               Vascular Surgeon              A surgeon who is specialised in
                                                                 the surgery of blood vessels and circulation.
Some words are in bold (for instance artery). These are
explained in the glossary at the end of the leaflet.
We hope that this information is helpful. If there is anything
you do not understand, please ask any of your vascular
team.
                          1                                                                        10
A Record of your recovery          Your Operation- Open AAA repair

Concern/ observation        Date   The aorta is the main artery which carries blood away from
                                   the heart through your abdomen and to the rest of your
                                   body. An aneurysm occurs when the walls of your arteries
                                   weaken, causing a swelling. An abdominal aneurysm is a
                                   swelling in the aorta, which is in your abdominal / tummy
                                   area.
                                   You are having, or may have had open surgery to repair
                                   your aortic aneurysm.

                                   Open surgery for aortic aneurysm repair is a major
                                   operation. The aorta is cut open, so that an artificial graft
                                   can be stitched inside. Sometimes the graft will attach onto
                                   the arteries at the top of each leg, and you may have an
                                   additional wound in your groins. The graft will stay in place
                                   forever.

                                   The Picture of your Scar
Record of exercise          Date   .




                                                                      2
                       9
Your early recovery on the ward                                     Looking after yourself
Most patients spend the first 24-48hrs in the intensive care        Aneurysms are often caused by arterial disease or
unit (ICU). When your condition is stable you will return to        atherosclerosis. There are certain factors that make people
the ward. You may still have a drip, a catheter and oxygen.         more at risk from atherosclerosis or peripheral vascular
                                                                    disease. These include:
Pain
                                                                       Age                           Diabetes
The incision (cut) in your abdomen is likely to be
uncomfortable at first. The nurses will monitor your level of          Smoking                       Being overweight
pain and initially you will be given painkillers via a tube in         High blood pressure           Lack of exercise
your back, or by a machine that you control yourself. Once             High cholesterol
you are eating and drinking, you will be able to take
painkilling tablets by mouth. The pain will slowly improve, but     Part of your medical treatment will be to reduce these risk
you may get twinges and aches for between 3-4 weeks.                factors.

Eating and drinking                                                 Stop smoking. Smoking is a major risk for arterial disease,
When your guts are working you will be allowed to start             and also increases the chances of getting a chest infection
drinking and then build up to a light diet, and your drip will be   and slows your recovery. We can help you to stop and refer
stopped. This can take up to 5 days.                                you to our smoking cessation counselor, who may suggest
                                                                    tablets or patches to help you.
It is normal to lose your appetite after surgery; as a result of
this you may lose weight. You may be seen by a dietician            Eat healthily. Being overweight reduces your general
who might recommend that you take supplementary drinks              mobility and can slow your recovery. Eat well, according to
to provide more nutrition to build your strength and aid            your appetite. Concentrate on low-fat diet foods and try to
recovery.                                                           include fruit and vegetables.

Your wound                                                          Exercise can boost your immune system and improve
There will be a dry dressing over your tummy wound. The             recovery. Take regular exercise or a short walk every day.
stitches will usually be removed between 7-10 days after the        Take a nap if needed. As you recover try to increase your
operation. If your stitches are not removed in hospital it may      activity, to having a daily walk.
be arranged for your GP’s practice or district nurse to
remove them and check your wound. Your wound will be
checked for any signs of infection, which if they occur, will be
treated.

                             3                                                                          8
Complications and what to look out for                            Moving around
                                                                  You will be helped to start moving and walking as soon as
If you think that there is something wrong with your wound        possible. Initially by sitting in the chair, and walking to the
once you get home, you should contact your GP, or the ward        bathroom and around the ward. During this time, some
from which you were discharged.                                   patients have to wear special support socks to help
                                                                  circulation, and you will be given a daily injection of heparin
The things to keep a look out for to tell the vascular team       to reduce the risk of blood clots. It is a good idea to exercise
are:                                                              your legs in bed. The physiotherapist will help you to cough
    Pain in your legs when walking                               and breathe, and If needed, will give you individual
    Pain, or a redness or swelling in the wound                  assistance and instructions to help you regain your normal
    Continued poor appetite, upset bowel movements               mobility. Moving around will not cause any damage to the
                                                                  graft, or to your wound, and will help your recovery.
If you have other concerns or questions during your recovery
at home, write them down in this leaflet to ask at your follow-   Medication
up appointment.                                                   The doctors will review your tablets. Most people will be sent
If you develop sudden pain or numbness in your legs that          home on a small dose of aspirin, to ensure the blood is less
does not get better within a few hours then contact the           sticky and a statin to reduce your cholesterol levels. If you
hospital immediately. Likewise if you experience severe pain      are unable to take aspirin an alternative drug maybe
in your back or stomach, pain or swelling in your calves, any     prescribed. Any blood pressure tablets will be reviewed. You
shortness of breath or pains in your chest, you must seek         might already be on these tablets.
medical attention as soon as possible.
                                                                  Preparing for discharge
If you need to go back to the hospital, it is best to ask
someone to take you.                                              Preparing for home should start as early as possible.
                                                                  Discharge is usually planned for about 10 days after your
Outpatient Follow Up                                              operation. It is a good idea to have someone to help look
                                                                  after you for a while, or some patients choose to live with a
After an open repair, recovery is slower, but the need for        member of their family for a short time. Think about the
follow-up is less. You may be seen in the vascular clinic 4-6     tasks, or activities you do, which may be difficult, especially if
weeks after your discharge. Remember to bring a list of your      you have a caring role for someone else. Stocking up on
queries if you have them. You will not need a scan to check       frozen or tinned items means you don't need to go shopping
the graft, but the doctor will ask you a few questions on how     immediately.
you have been doing. Once you have recovered from your            If there are complications with your recovery you may need
operation, you will be discharged back to the care of your        to stay in hospital a little longer.
family doctor.

                          7                                                                          4
Recovery at home                                                   Working
                                                                   When to return to work will depend on the type of job that
Recovery times vary, and it can take several weeks to feel         you do. Most people need to wait 6-12 weeks before
‘back to normal’, and depends on your health and activity          returning to work, and may work shorter hours for a few
before surgery.                                                    weeks, and build back up to their normal hours. Your GP will
                                                                   be able to advise you further.
Your wound                                                         Sex
Your wound will be red at first but will gradually fade over six   You can resume your sex life when you feel comfortable.
months or more. You can wash normally with mild soap and           Sometimes, men have problems sustaining an erection after
water when you have a bath or shower. If your wound                this operation, as the nerve supply may be disturbed. This
becomes red, sore or is oozing please let your GP know, as         affects approximately 10% of men. It is not known what
this could be a sign of an infection. Protecting your scar from    effect, if any, AAA repair has on a woman’s sex life. If you
exposure to sunlight during the first year after having surgery    experience problems, your GP may be able to provide
will prevent the scar becoming darker.                             treatment to help.
Sleeping and feeling tired                                         Driving
It is normal to feel tired for at least 4-6 weeks after your       For safety and insurance reasons patients are unable to
operation. You may feel low in spirits. You might need a           drive for 4 weeks after their operation. If you are in doubt,
short sleep in the afternoon for a few weeks, as you               you should check with your GP and insurance company.
gradually increase your level of activity. It is good for you
and your family to be aware of this.

Diet and appetite                                                  Exercise programme
It can take a few weeks for your appetite and diet to return to    Here are some tips for planning your exercise at home:
normal and to regain any weight you may have lost in
hospital. Try taking smaller regular meals. You may find your      Week1         Walking gently around the house. Take an
bowel motions take time to become more regular again.                            afternoon nap.
                                                                   Week 2        Take a daily 3-5 minute small walk around your
Mobility, hobbies and activity- start slowly!                                    house and garden. Take an afternoon nap, if
The muscles underneath your wound may take up to 6-8                             needed.
weeks to fully heal. During this time, you should not lift heavy   Week 3        Take a short 5-10 minute daily walk in the
objects, or undertake strenuous activities or sports such as                     morning and afternoon. Take a nap in the
golf. Taking regular exercise such as a short walk combined                      afternoon if needed
with rest is recommended for the first few weeks which you         Week 4        Take a daily 10-20 minute daily walk, twice a
can gradually increase. Taking on light household chores,                        day. You may also still need a daily nap.
and walking around your house is a good starting point.

                             5                                                                        6

				
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